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Panic Disorder
redirect Panic disorder , | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = }} Panic disorder is a diagnosed psychiatric mental condition that causes the sufferer to experience sporadic, intense, and often reoccurring panic attacks. Symptoms Panic disorder sufferers usually have a series of intense episodes of extreme anxiety, known as panic attacks. These attacks may last from several minutes to hours, and may vary in intensity and specific symptoms of panic over the duration (i.e. rapid heartbeat, perspiration, dizziness, dyspnea,trembling, psychological experience of uncontrollable fear, etc.). Some individuals deal with these events on a regular basis—sometimes daily or weekly. The outward symptoms of a panic attack often cause negative social experiences (i.e. embarrassment, social stigma, ostracization, etc.). As a result, as many as 36% of all individuals with panic disorder also have agoraphobia. Occurrence Panic disorder is a serious health problem but can be successfully treated. It is estimated that 1.7 percent of the adult American population alone has panic disorder. It typically strikes in young adulthood; roughly half of all people who have panic disorder develop the condition before age 24, though some sources say that the majority of young people affected for the first time are between the ages of 25 and 30. Women are twice as likely as men to develop panic disorder. Panic disorder can continue for months or even years, depending on how and when treatment is sought. If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by attempts to avoid or conceal the condition. In fact, many people have had problems with friends and family or lost jobs while struggling to cope with panic disorder. In some individuals symptoms may occur frequently for a period of months or years, then many years may pass symptom free. In others, the symptoms persist at the same level indefinitely. There is also some evidence that many individuals (especially those who develop symptoms at an early age) may experience a cessation of symptoms naturally later in life (i.e. past age 50). It is advised however, not to alter any current treatment or medications without the advice of a physician. For people who seek active treatment early in development, the majority of symptoms can disappear within a few weeks, with no permanent negative effects once treatment is completed. Although this does by no means apply to all people Treatment Panic disorder is real and potentially disabling, but it can be controlled. Because of the disturbing symptoms that accompany panic disorder, it may be mistaken for a life-threatening physical illness. This misconception often aggravates or triggers future attacks. People frequently go to hospital emergency rooms when they are having panic attacks, and extensive medical tests may be performed to rule out these other conditions, thus creating further anxiety. Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy. The mental health professionals that typically can assist an individual in treatment of panic disorder are psychiatrists, psychologists, mental health counselors, and social workers. To pursue a medical treatment for panic disorder, one should visit a medical doctor, typically a psychiatrist. Psychotherapy is typically provided by a clinical or counseling psychologist, a Licensed Professional Counselor (LPC), or a Licensed Clinical Social Worker (LCSW). In remote areas, or when a psychatrist is unavailable, a general practice physician ("family doctor") may be competent to manage the pharmacological ("medications") treatment in coordination with a psychologist or LCSW. A psychiatrist is, by training, better prepared than a general practice physician in the pharmacological treatment and should be sought out if available. Medications can be used to break the psychological connection between a specific phobia and panic attacks. Medications can include: * antidepressants (SSRIs, MAOIs, etc.) : these are taken regularly every day, and build a resistance to the occurrence of the symptoms. Although these medications are described as "antidepressants," nearly all of them have anti-panic properties as well - many panic sufferers do not have classical symptoms of depression, and may be misled by the name "antidepressant" into believing these drugs are not targeted to their symptoms, when they are often the most effective treatment in combination with psychotherapy. * anti-anxiety drugs (benzodiazepines) : these drugs are taken during or at the onset of panic attacks; no benefit is realized by their regular use (except where panic episodes are experienced regularly), and these drugs may be habit forming if not used according to a physician's directions. They are often most effective at the beginning of treatment when the resistance properties of the antidepressants have not yet built up, and are generally utilized less and less as other parts of the treatment (antidepressants, psychotherapy) become more effective. Exposure to the phobia trigger multiple times without a resulting panic attack (due to medication) can often break the phobia-panic pattern, allowing people to function around their phobia without the help of medications. However, minor phobias that develop as a result of the panic attack can often be eliminated without medication through monitored cognitive-behavioral therapy or simply by exposure. Usually, a combination of psychotherapy and medications produces good results. Some improvement may be noticed in a fairly short period of time -- about 6 to 8 weeks. Often, it may take longer to find the right pair of medications and mental health professional. Thus appropriate treatment by an experienced professional can prevent panic attacks or at least substantially reduce their severity and frequency -- bringing significant relief to 70 to 90 percent of people with panic disorder. Relapses may occur, but they can often be effectively treated just like the initial episode. In addition, people with panic disorder may need treatment for other emotional problems. Clinical depression has often been associated with panic disorder, as have alcoholism and drug addiction. Research has also suggested that suicide attempts are more frequent in people with panic disorder, although this research remains controversial. About 30% of people with panic disorder use alcohol and 17% use other psychoactive drugs. This is in comparison with 61% (alcohol)http://www.cdc.gov/nchs/fastats/alcohol.htm and 7.9% (other psychoactive drugs) http://www.cdc.gov/nchs/fastats/druguse.htm of the general population who use alcohol and psychoactive drugs, respectively. It often varies between individual cases whether any observed drug use worsens the condition, or is initated by the sufferer to alleviate the condition ("self medication"). Most stimulant drugs (caffeine, nicotine, cocaine) would be expected to worsen the condition, since they directly increase the symptoms of panic, such as heart rate. The medically established psychoactive properties of marijuana present a special case - at low doses there may be some anti-anxiety psychological effects comparable to those of benzodiazepines, whereas at some undefined threshold (as dose is increased), marijuana has been shown to produce extreme anxiety on its own, with an intensity potentially comparable to that of the panic disorder symptoms themselves.http://www.yale.edu/opa/newsr/04-06-14-01.all.html As with many disorders, having a support structure of family and friends who understand the condition can help increase the rate of recovery. During an attack, it is not uncommon for the sufferer to develop irrational, immediate fear, which can often be dispelled by a supporter who is familiar with the condition. For more serious or active treatment, there are support groups for anxiety sufferers which can help people understand and deal with the disorder. Other forms of treatment include journalling, in which a patient records their day-to-day activities and emotions in a log to find and deal with their personal stresses. Breathing exercises, such as diaphragmatic breathing, can also be found helpful. In some cases, a therapist may use a procedure called interoceptive exposure, in which the symptoms of a panic attack are induced in order to promote coping skills and show the patient that no harm can come from a panic attack. Stress-relieving activities such as tai-chi, yoga, and physical exercise can also help ameliorate the causes of panic disorder. Many physicians will recommend stress management, time management, and emotion-balancing classes and seminars to help patients avoid anxiety in the future. Research has also shown that the herbal supplement 5-HTP can be used to treat panic disorders by its ability to boost serotonin levels. This works by providing the body with the raw material to make serotonin, as opposed to SSRIs which work by recycling serotonin. Causes Panic disorder has been found to run in families, and this may mean that inheritance plays a strong role in determining who will get it. It has also been found to exist as a co-morbid condition with many hereditary disorders, such as bipolar disorder, and alcoholism. However, many people who have no family history of the disorder develop it. Other biological factors, stressful life events, environment, and thinking in a way that exaggerates relatively normal bodily reactions are also believed to play a role in the onset of panic disorder. Often the first attacks are triggered by physical illnesses, major stress, or certain medications. People who tend to take on excessive responsibilities may develop a tendency to suffer panic attacks. Post-traumatic stress disorder (PTSD) patients also show a much higher rate of panic disorder than the general population. The exact causes of panic disorder are unknown at this point. Studies in animals and humans have focused on pinpointing the specific brain areas involved in anxiety disorders such as panic disorder. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body's fear response is coordinated by a small but complicated structure deep inside the brain called the amygdala. Eating disorders have also been linked to have caused panic attacks in several people. Some mood disorders can cause panic disorder. In addition to clinical depression, bipolar disorder can cause panic disorder in some people. Due to the nature of the fight or flight response many cases of panic disorder may be linked with the limbic system and be initiated by those biological factors that could be biological, reinterpreted emotionally as a threat to survival, such as hypoxia (lack of oxygen). If panic disorder is experienced more severely during sleep, it would be recommended to have the sufferer evaluted for conditions such as sleep apnea or hypopnea. A sleep-related panic disorder could be most easily distinguished from a night terror by the ability (usually instantaneous) of the panic disorder sufferer to regain full consciousness, unlike the night terror sufferer. Stimulants are a rather common cause for panic attacks. An excess of common stimulants such as caffeine and nicotine often can induce panic attacks in less experienced users. Chemicals, including carbon monoxide, in tobacco smoke can also trigger panic attacks in certain people. Some people's response to small amounts of carbon monoxide is to panic. Not surprisingly, the attacks stop or get much less severe after they quit the cause, such as smoking. Psychological explanations of panic disorder have also been put forward. Clark (1986) suggests that panic disorder is often caused by "catastrophic misinterpretations", whereby normal bodily sensations, often normal responses to anxiety such as palpitations and sweating, are interpreted as indicating something seriously wrong such as a heart-attack, and this interpretation can be done either consciously or subconsciously. Quite a bit of evidence exists for this theory. For example, activating catastrophic misinterpretations increases anxiety and panic; panic attacks can be reduced as a result of cognitively challenging these misinterpretations; with ambiguous events questionnaires, panic-disorder patients interpret ambiguous sensations more catastrophically than controls. Further, a study by Ehler which provided false heart-rate feedback to participants found that those with panic disorder react with far greater anxiety. DSM-IV Criteria DSM-IV Diagnostic Criteria for Panic Disorder With or Without Agoraphobia A. Both (1) and (2): # recurrent unexpected panic attacks # at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following: *persistent concern about having additional attacks *worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy") a. significant change in behavior related to the attacks b. Presence or Absence of Agoraphobia c. The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism). d. The panic attacks not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Post-traumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives). References External links * Anxiety Disorders Association of America * Overcome panic disorder and agoraphobia - tips by clinical psychologist David Carbonell, based on cognitive-behavioral therapy * UK based forum for sufferers of panic disorder * Tips for Panic Attacks * My Brain: My Friend, My Enemy -->